Long-term bone and lung consequences associated with hospital-acquired severe acute respiratory syndrome: a 15-year follow-up from a prospective cohort study

摘要

The most severe sequelae after rehabilitation from SARS are femoral head necrosis and pulmonary fibrosis. We performed a 15-yearfollow-up on the lung and bone conditions of SARS patients. We evaluated the recovery from lung damage and femoral headnecrosis in an observational cohort study of SARS patients using pulmonary CT scans, hip joint MRI examinations, pulmonaryfunction tests and hip joint function questionnaires. Eighty medical staff contracted SARS in 2003. Two patients died of SARS, and78 were enrolled in this study from August 2003 to March 2018. Seventy-one patients completed the 15-year follow-up. Thepercentage of pulmonary lesions on CT scans diminished from 2003 (9.40 ± 7.83)% to 2004 (3.20 ± 4.78)% (P 0.001) and remainedstable thereafter until 2018 (4.60 ± 6.37)%. Between 2006 and 2018, the proportion of patients with interstitial changes who hadimproved pulmonary function was lower than that of patients without lesions, as demonstrated by the one-second ratio (FEV1/FVC%, t = 2.21, P = 0.04) and mid-flow of maximum expiration (FEF25%–75%, t = 2.76, P = 0.01). The volume of femoral head necrosisdecreased significantly from 2003 (38.83 ± 21.01)% to 2005 (30.38 ± 20.23)% (P = 0.000 2), then declined slowly from 2005 to 2013(28.99 ± 20.59)% and plateaued until 2018 (25.52 ± 15.51)%. Pulmonary interstitial damage and functional decline caused by SARSmostly recovered, with a greater extent of recovery within 2 years after rehabilitation. Femoral head necrosis induced by largedoses of steroid pulse therapy in SARS patients was not progressive and was partially reversible.